支气管扩张症患者肺部CT影像学特征与临床表现的相关性

Correlation between chest CT features and clinical characteristics of patients with bronchiectasis

目的 分析支气管扩张症(简称支扩)患者的肺部CT影像学特征与临床表现的相关性.方法 从2010年1月至2017年12月,于山东省5家三级综合性医院纳入经肺部高分辨率CT(HRCT)确诊为支扩、年龄≥18岁的患者.分析患者肺部HRCT影像学特征与其病因、临床表现、肺功能、痰培养及预后等临床特征的相关性.结果 共纳入410例患者,肺部HRCT表现类型依次是柱状192例(46.8%)、囊状188例(45.9%)及静脉曲张型30例(7.3%),HRCT表现评分[6.0(4.0,7.0)]分.特发性支扩262例(69.3%),是最常见的病因;囊状支扩中特发性支扩占比均显著高于柱状和静脉曲张型支扩患者(71.8%比58.3%和50.0%;均P<0.017).与柱状支扩相比,囊状支扩患者更易出现咳痰、呼吸困难、发热及湿罗音等临床表现(P<0.017);与HRCT表现评分1~4分的支扩患者相比,≥8分者更易出现咳嗽、咳痰、呼吸困难、发热、湿罗音及杵状指等临床表现(P<0.017).囊状支扩和静脉曲张型支扩患者中肺通气功能异常者占比均显著高于柱状支扩患者(86.7%和86.7%比51.0%;均P<0.017);HRCT表现评分与肺功能指标呈显著负相关(P<0.001).囊状支扩患者的急性加重次数、住院次数及BSI评分均显著高于柱状支扩患者(P<0.017);HRCT表现评分与急性加重次数、住院次数及支扩严重度指数评分均呈显著正相关(P<0.001).囊状支扩和静脉曲张型支扩患者的病死率均显著高于柱状支扩患者(9.0%和10.0%比2.1%;均P<0.017);与HRCT表现评分1~4分的支扩患者相比,≥8分的支扩患者具有较高的病死率(15.9%比0.9%;P<0.017).结论 支扩患者的肺部HRCT表现与临床表现存在相关性.囊状支扩患者的临床表现、肺功能及预后均较柱状支扩差;HRCT表现评分越高,患者的临床表现、肺功能及预后越差.

Objective To analyze the features of chest CT imaging in adult patients with bronchiectasis and explore its correlation with clinical characteristics. Methods From January 2010 to December 2017, patients with bronchiectasis diagnosed by chest high-resolution CT (HRCT) and aged at or above 18 years old in 5 general hospitals of Shandong province were included in the study. The correlations between the HRCT imaging features and etiology, clinical manifestations, lung function, sputum culture, prognosis and other characteristics were analyzed. Results There were 410 bronchiectasis patients included in the study. The chest HRCT imaging of bronchiectasis were divided into three types, including columnar 46.8%, cystic 45.9% and varicose 7.3%, respectively. The HRCT imaging score was [6.0 (4.0, 7.0)]. In addition, the most common etiology of bronchiectasis was idiopathic (262, 69.3%). The proportion of idiopathic bronchiectasis in cystic bronchiectasis patients was significantly higher than that in columnar and varicose bronchiectasis (71.8% vs 58.3%, 50.0%;both P<0.017). Compared with columnar bronchiectasis, patients with cystic bronchiectasis were more likely to suffer from clinical manifestations such as cough , dyspnea, fever and wet rales (P<0.017). Compared with patients with HRCT scores of 1 to 4, patients with scores ≥8 were more likely to suffer from cough, dyspnea, fever, wet rales and clubbing (P<0.017). The proportions of pulmonary ventilatory dysfunction were significantly greater in patients with cystic bronchiectasis and varicose bronchiectasis than columnar bronchiectasis (86.7%, 86.7%vs 51.0%;both P<0.017). The HRCT scores were significantly negatively correlated with pulmonary function (P<0.001). The number of acute exacerbations, hospitalizations, and bronchiectasis severe index scores in patients with cystic bronchiectasis were significantly higher than those with columnar bronchiectasis (P<0.017). There was a significantly positive correlation between HRCT scores and the number of acute exacerbations, hospitalizations and the bronchiectasis severity index scores (P<0.001). The mortality of patients with cystic and varicose bronchiectasis was significantly higher than that of patients with columnar bronchiectasis (9.0%, 10.0% vs 2.1%;both P<0.017). Compared with patients with HRCT scores of 1 to 4, patients with scores ≥8 had a higher mortality rate (15.9% vs 0.9%;P<0.017). Conclusions There is a correlation between HRCT findings and clinical manifestations in patients with bronchiectasis. The clinical manifestations, lung function and prognosis of patients with cystic bronchiectasis are worse than those of the columnar bronchiectasis;the higher the HRCT scores are, the worse the clinical manifestations, lung function and prognosis of the patients are.